DangerousContraindicated
Cocaine and amphetamine/dextroamphetamine are both sympathomimetic stimulants. Using them together can intensify tachycardia, hypertension, coronary vasospasm, overheating, anxiety, and arrhythmia risk. The danger is higher with high stimulant doses, dehydration, strenuous activity, or any history of heart disease, high blood pressure, panic attacks, or stimulant use disorder.
Recommendation: Do not use cocaine while taking amphetamine/dextroamphetamine. If cocaine exposure occurs, do not take extra stimulant doses and avoid exercise or overheating. Seek emergency care for chest pain, fainting, severe headache, severe agitation, shortness of breath, or a racing or irregular heartbeat.
DangerousContraindicated
MDMA is a substituted amphetamine with strong serotonin, norepinephrine, and dopamine releasing effects. Combining it with amphetamine/dextroamphetamine can increase stimulant toxicity, including hypertension, tachycardia, hyperthermia, dehydration, agitation, panic, and arrhythmias. Risk rises sharply with dancing or strenuous activity, hot environments, redosing, or other serotonergic or stimulant substances.
Recommendation: Do not use MDMA while taking amphetamine/dextroamphetamine. Do not redose either substance to chase effects or stay awake. Seek emergency care for high fever, confusion, severe agitation, chest pain, fainting, seizure, severe headache, or a racing or irregular heartbeat.
ModerateCaution
Nicotine can add sympathetic stimulation to amphetamine/dextroamphetamine and may also reinforce stimulant use patterns. The combination can worsen palpitations, jitteriness, anxiety, insomnia, appetite suppression, and blood pressure or heart rate elevation. Risk is higher with high-nicotine vaping, frequent nicotine pouches, multiple stimulant doses, or underlying cardiovascular disease.
Recommendation: Limit nicotine while taking amphetamine/dextroamphetamine, especially around peak stimulant effect. Check blood pressure and pulse if you notice palpitations, chest tightness, anxiety, or headaches. Seek urgent care for chest pain, fainting, severe shortness of breath, or an irregular heartbeat.
SeriousCaution
Amphetamine/dextroamphetamine can partially counter alcohol-related psychomotor slowing without making the person sober. This can make intoxication feel less obvious and encourage more drinking, driving, risky activity, or additional stimulant use. Alcohol and stimulants can also add cardiovascular strain, especially with binge drinking or dehydration.
Recommendation: Avoid alcohol on days you take amphetamine/dextroamphetamine when possible. If you drink, keep intake low, do not drive, and do not take extra stimulant doses to stay alert. Seek care for chest pain, fainting, severe agitation, confusion, or an irregular heartbeat.
ModerateTiming Sensitive
High-dose Vitamin C products are usually ascorbic acid, and acidifying conditions can lower amphetamine blood levels by increasing renal clearance of amphetamine. This can make amphetamine/dextroamphetamine feel weaker or wear off sooner in some patients, though ordinary dietary vitamin C is less likely to cause a major effect. The risk is most relevant with large supplemental doses, acidic powders, or inconsistent timing.
Recommendation: Keep Vitamin C intake consistent and avoid taking high-dose Vitamin C within 2 hours of amphetamine/dextroamphetamine. If you use gram-level Vitamin C daily, take it later in the day and tell your prescriber if your stimulant effect changes. Do not increase stimulant doses on your own to compensate.
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